Hastings Center Report

Recent media reports have drawn widespread attention to the experiences of patients who are denied reproductive services at Catholic hospitals. For some patients, such as those experiencing miscarriage, denial of appropriate treatment can lead to serious health consequences. However, many patients are unaware of the limitations on services available at religiously affiliated health care institutions. As a result, patients' ability to make informed and autonomous decisions about where to seek treatment is hindered...

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, "sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives." It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors...

Like many other bioethicists, I often give talks on clinical topics that may touch on the patient's right of autonomy with regard to medical treatment and, from there, may move to questions about whether said patient has the capacity to exercise said right. When I get to that subject, I might ask, "Is this person competent to refuse treatment?" A stunned silence falls over the room, until finally a hand shoots up. "'Competent' is a legal term," I am instructed. "Don't you mean to ask whether he has the capacity to make decisions for himself?" The tone suggests that I'm being helped to make a very important distinction...

One day soon it may be possible to replace a failing heart, liver, or kidney with a long-lasting mechanical replacement or perhaps even with a 3-D printed version based on the patient's own tissue. Such artificial organs could make transplant waiting lists and immunosuppression a thing of the past. Supposing that this happens, what will the ongoing care of people with these implants involve? In particular, how will the need to maintain the functioning of artificial organs over an extended period affect patients and their doctors and the responsibilities of those who manufacture such devices? Drawing on lessons from the history of the cardiac pacemaker, this article offers an initial survey of the ethical issues posed by the need to maintain and service artificial organs...

The doctors were frustrated. They could see only two options. Neither was very desirable. They could stop the ventilator and let the baby die. Or they could do a tracheostomy and start preparations to discharge him on a ventilator. The parents wanted a third option. They kept hoping that their baby would get better. The doctors were pretty sure that that wasn't going to happen.

I joined The Hastings Center this past summer, after graduating from Duke University, where I researched advancements in neuroscience and genomics and their import for law, ethics, and policy. This research required, to an extent, faith in the idea that researchers can identify pathways by which genes combine with epigenetic and environmental factors to affect neuronal activity and influence behaviors. Throughout my first months here, I have puzzled over broad critiques of "genomic hype" in recent literature, which clash with the optimistic rhetoric found in the Human Genome Project and the Precision Medicine Initiative...

Crowdfunding websites allow users to post a public appeal for funding for a range of activities, including adoption, travel, research, participation in sports, and many others. One common form of crowdfunding is for expenses related to medical care. Medical crowdfunding appeals serve as a means of addressing gaps in medical and employment insurance, both in countries without universal health insurance, like the United States, and countries with universal coverage limited to essential medical needs, like Canada...

When the Supreme Court of Canada recognized a constitutional right to "medical assistance in dying" last year-and the nation's Parliament enacted legislation to implement the right earlier this year-Canadian lawmakers could look to two different models for guidance. The Netherlands and Belgium recognize a broad right to assistance in dying, while Oregon and elsewhere in the United States have a narrow right. In some ways, assistance in dying in Canada follows the Dutch-Belgian approach, while, in other ways, it seems more American...

In the current issue of The New Atlantis, Daniel Sarewitz, professor of science and society at Arizona State University, argues that science is broken because it is managed and judged by scientists themselves, operating under Vannevar Bush's famous 1945 declaration that scientific progress depends on the "free play of free intellects … dictated by their curiosity." With that scientific agenda, society ends up with a lot of unnecessary, uncoordinated, and unproductive research. To save science, holds Sarewitz, we need to put it in the hands of people who are looking for practical solutions to specific problems...

Glenn Cohen, Holly Fernandez Lynch, and Christopher Deubert are right in their article "A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust" that the problem with the medical care rendered to National Football League players is not that the doctors are bad, but that the system in which they provide care is structured badly. We saw some of the problems this system causes last season in what happened to Case Kenum, a quarterback for the Los Angeles Rams who, despite having a possible concussion from a game injury, was allowed to continue to play, with a concussion spotter in the booth and coaches, teammates, seven game officials, and two full training staffs present...

In the article "A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust," Glenn Cohen et al. write, "The [NFL's] current structure forces club doctors to have obligations to two parties-the club and the player-and to make difficult judgments about when one party's interests must yield to another's." I can understand why some might be suspicious about bias in the current NFL medical system, in which the club doctors have a professional duty to put their player-patients' best interests first yet are employed by clubs, which have a primary goal of winning football games...

The National Football League Physicians Society read with disappointment the article "A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust." In spite of the authors' suggestions, NFL physicians are accomplished medical professionals who abide by the highest ethical standards in providing treatment to all of their patients, including those who play in the NFL. It defies logic for the authors not to have engaged experienced and active NFL physicians from the very start of their effort to explore, challenge, and recommend significant alterations to the delivery of health care to NFL players...

Beginning my third year with the Kansas City Chiefs and being also a medical student at McGill University, I was at first a little reluctant to comment on Glenn Cohen et al.'s critique of the National Football League's structure involving player health and team doctors, but the opportunity to provide a perspective as both a football player and a medical student was too much to forgo. Because of my athletic and academic background, I am often asked what I think about injuries in professional sports and about the role of sports medicine physicians, and Cohen et al...

Our article "NFL Player Health Care: Addressing Club Doctors' Conflicts of Interests and Promoting Player Trust" focused on an inherent structural conflict that faces club doctors in the National Football League. The conflict stems from club doctors' dual role of providing medical care to players and providing strategic advice to clubs. We recommended assigning these roles to different individuals, with the medical staff members who are responsible for providing player care being chosen and subject to review and termination by a committee of medical experts selected equally by the NFL and the NFL Players Association...

The job of being a sports team physician is difficult, regardless of the level, from high school to the National Football League. When a sports league receives the intensity of attention leveled at the NFL, though, a difficult occupation becomes even more challenging. Even for the NFL players themselves, players' best interests regarding health issues are often unclear. Football players are, as a lot, highly competitive individuals. They want to win, and they want to help the team win. It's a warrior culture, and respect is earned by playing hurt...

How can we ensure that players in the National Football League receive excellent health care they can trust from providers who are as free from conflicts of interest as realistically possible? NFL players typically receive care from the club's own medical staff. Club doctors are clearly important stakeholders in player health. They diagnose and treat players for a variety of ailments, physical and mental, while making recommendations to the player concerning those ailments. At the same time, club doctors have obligations to the club, namely to inform and advise clubs about the health status of players...